Main Assignment
Assignment Description:
Data-Based Changes
Write a 1500 word essay addressing each of the following points/questions.
Be sure to completely answer all the questions for each number item.
There should be three sections, one for each item number below, as well the introduction (heading is the title of the essay) and conclusion paragraphs.
Besides from minor introduction and conclusion paragraphs for each topic like mentioned above, Please write one main introduction as to what it is going to be presented and conclusion for the whole paper.
Separate each section in your paper with a clear heading that allows your professor to know which bullet you are addressing in that section of your paper.
Support your ideas with at least three (4) scholarly citations using APA citations in your essay.
Make sure to reference the citations using the APA writing style for the essay.
The cover page and reference page do not count towards the minimum word amount.
- Identify the current role of the informatics nurse and predict the future role of the informatics nurse, based on scholarly sources.
- Explain what is meant by connected health.
Provide three examples of connected health in today’s healthcare environment.
Explain the benefits and drawbacks of each.
- In what ways has informatics impacted public health –
please provide at least three examples.
Start by reading and following these instructions:
- Study the required chapter(s) of the textbook and any additional recommended resources. Some answers may require you to do additional research on the Internet or in other reference sources. Choose your sources carefully.
- Consider the discussion and the any insights you gained from it.
- Create your Assignment submission and be sure to cite your sources, use APA style as required, check your spelling.
The following specifications are required for this assignment: APA 7th edition.
- Length: 500 words per essay prompt/section (1500 total for this assignment); answers must thoroughly address the questions in a clear, concise manner.
- Structure: Include a title page and reference page in APA style. These do not count towards the minimal word amount for this assignment. All APA Papers should include an introduction and conclusion.
- References: Use the appropriate APA style in-text citations and references for all resources utilized to answer the questions. Include at least three (4) scholarly sources to support your claims.
Reading assignment for this assignment. – Chapter 17
APA Citation of the book :
Hebda, T. L., Czar, P., & Hunter, K. (2018). Handbook of Informatics for Nurses & Healthcare Professionals (6th Edition). Pearson Education (US). https://bookshelf.vitalsource.com/books/9780134677064
Chapter 17
Why Informatics?
What does this have to do with informatics? The Health Information Technology for Economic and Clinical Health Act (HITECH Act) strongly recommended that hospitals and healthcare providers increase the meaningful use of health information technology (HIT). Why? For one thing, it is necessary to decrease overall healthcare costs and to improve population health outcomes. In order for this to take place, healthcare personnel must be properly prepared to utilize HIT efficiently. This preparation begins with nursing education. For example, electronic health record systems (EHRS) are paramount in the healthcare environment today for data collection, collaboration, and communication. Significant errors impacting patient outcomes have long plagued the healthcare community, and IT, such as EHRS, has made strides to improve patient outcomes, assure safe delivery of care, and reduce healthcare errors (Herbert & Connors, 2016). Nursing faculty must prepare students for this environment. It is paramount that faculty are committed to the integration of informatics as well as EHRS throughout the academic process, in order to adequately prepare nursing students for clinical practice. According to Tellez (2012), major nursing, healthcare services, and national health policy organizations all recommend that “BSN curricular revisions are required to prepare nurses to meet the challenges of the 21st-century healthcare system” (p. 232). The healthcare industry has recognized the need for improved communication between IT personnel and healthcare practitioners, in order to address the issues of patient care through the creation of informatics nurse-specialist positions (Cassano, 2017). To meet the needs of nursing students today, it is essential to provide learning experiences with IT that replicates, as closely as possible, what the student will encounter in the actual clinical environment. The Institute of Medicine (IOM) suggested that integrating EHRS into nursing education can also pave the way for evidence-based nursing practice (Wyatt, Li, Indranoi, & Bell, 2012).
Preparing the Learner
Organizations, such as the American Association of Colleges of Nursing (AACN), IOM, and Quality and Safety Education of Nurses (QSEN, 2013), have encouraged schools of nursing to increase patient safety through the use of IT in nursing education. Tools can be as simple as a PowerPoint presentation, or as complex as a high-fidelity simulation. The question is, how does one utilize IT in education, when the age of learners today could conceivably range from the baby boomer to the so-called net generation? The immediate answer to this is not a simple one and is the reason that exploration of a variety of IT uses should be a priority consideration that can appeal to a wide range of learners. The students of today expect to utilize IT in all areas of their life, and this includes education as well. Let’s begin by examining some of the benefits and barriers to the use of technology in nursing education.
Educational Software Sources
Educational software can provide learners with interactive experiences that may be viewed anytime and anywhere. The purpose of these tools may be to tutor learners in an endless range of topics, or to test them to determine attainment of outcomes and level of proficiency.
A software application may be sold in a variety of ways. It may be acquired as a stand-alone product, or it can come bundled with other resources as part of a learning package. Vendors may offer organizations a comprehensive solution that includes, not only the educational titles, but also the system software that can store, deliver, and track user performance.
The National League for Nursing Simulation Innovation Resource Center (NLN SIRC), at sirc.nln.org, is an excellent source of information regarding simulation products that are marketed for nursing education. Everything from injection pads to human patient simulators is listed.
Publishers are excellent places to search for software on topics that match their textbooks. Users may purchase an access code that allows them to view the software remotely, using a browser connected to the Internet.
An increasing number of vendors will provide educators with analytics that inform them of the status and progress of their learners. These diagnostic features can alert educators about which learners may have problems, allowing for early intervention that will encourage success.
A key factor to using much of today’s educational software is access to the Internet. Software that streams from a remote server to the learner’s device requires a reliable and sustained connection to operate smoothly. Learners who live in technologically underserved areas may find it difficult to engage in these experiences at home, and may need to seek locations such as libraries, workplaces, and businesses that offer access to the Internet.
Barriers and Benefits
Some of the challenges of utilizing IT in nursing education are the compatibilities or incompatibilities of certain products, as well as the phasing out of other products due to ever-evolving competition by IT companies. Sometimes products become outdated. Faculty may have concerns that the technology adds to their workload, contributes to alterations in faculty roles, leads to reduction in overall course quality, is not compatible with their teaching styles and values, or consumes time and resources for learning its use (Fiedler, Giddens, & North, 2014; Pereira & Wahi, 2017).
Conversely, the benefits of utilizing IT in education are many. Students who require a different type of inspiration to learn, or students who struggle with traditional education teaching methodologies, may benefit from some form of elearning. Flexibility of when and where one wishes to participate in class is an attractive benefit for many students, who can attend class via mobile phone applications, laptops, and tablet computers. Students are individuals who bring unique learning styles, life experiences, and needs to the classroom, whether it is a virtual or a traditional bricks-and-mortar location. Educational technology has the capability of bringing forth relevant and modern learning activities and opportunities for the diverse learner of today.
In an effort to facilitate student learning, educators need to develop the skills to use technology to support successful teaching and learning experiences. Additionally, choosing among various educational technologies, and applying them in a manner that results in a successful learning environment, promotes interactive collaboration, and can set the stage for lifelong learning. Integration of IT should not serve as a replacement for faculty, but rather complement a course, enhancing the faculty member’s teaching style, and curriculum.
Necessary Tools
What is different about teaching with IT, rather than the traditional style that many of us grew up with? Using educational IT, along with an instructionally sound curriculum, can be a powerful synthesis of tools to aid in the engagement and successful graduation rates of online students. When faculty utilize a systematic design process to develop their online courses, learning outcomes and retention rates are at least equal to traditional or face-to-face (F2F) classroom learning environments. For nontraditional students, online courses may provide courses not otherwise available (James, Swan, & Daston, 2016). Manning-Ouelette and Black (2017) discovered that students in online courses are more engaged in deep learning than students in traditional learning settings.
Development of an online course is similar to that of a F2F classroom course, beginning with the course description, development of course objectives or outcomes, alignment with program outcomes and regulatory agencies, teaching strategies, course content development, and methods of evaluation. There is no hard and fast rule for getting started, but in general, it is essential to consider the many types of resources available. This may include support for the technology (fiscal as well as technical), student levels and learning styles compatibility with the current learning platform, and ease of integration. Other important points to ponder consist of faculty teaching preferences and limitations, pedagogical reliability, and the ability to achieve and assess outcomes. It is important to consider that it may be prudent to start out slowly: adding too many forms of IT at once in one course could end up being disastrous, as well as overwhelming for students and faculty alike. IT should complement the course, not overpower it.
Information Technology in the Classroom
Face-to-face classrooms, with the reputation of having a one-way direction of communication through lectures, can be greatly enhanced through the addition of IT (Sawang, O’Connor, & Ali, 2017). Though lecture is still an efficient way of delivering information to a larger group, going a step further—perhaps by adding an audience response system (ARS), a video, a writeable tablet device with an outline provided, or a PowerPoint presentation—may benefit students. The classroom, as well as the student, of today is very different than those from 20 or even 10 years ago, but so is healthcare, and nurse educators must rise to the challenge. Realistically, not all nurse educators are likely to pursue the use of new technologies in their classrooms. There is, now more than ever, a need for nurse educators who are creative, innovative, and who welcome the challenges of trying new technological teaching methods. Every nurse educator can use teaching methods that not only encourage learning, but also give the student the unique opportunity to be able to generate personal learning, rather than to simply sit and absorb content from faculty. The integration of information technology into the realm of nursing education allows the student the opportunity to hypothesize, problem-solve, learn the art of collaboration and respectful debate, associate the integration of nursing theory with professional nursing practice, and become an active participant in the way they learn (Oermann, 2015).
Web-Based Environments
In a 2017 systematic review of the literature, the software type of ET most frequently mentioned (52.9%) was Web 2.0 (Sosa Neira, Salinas, & de Benito Crosetti, 2017). Web 2.0 is best defined as the second generation in the development of the World Wide Web that focuses more on user collaboration, or communication, through the sharing of content, along with social networking. In other words, these web applications go beyond the display of privately viewed, individual pages, and enables a community of users to interact with the site—allowing each individual to add or update information. Facebook and Twitter are examples of web-based social-networking sites, where individuals post, update, or add to information seen by large groups of people. Web applications, such as Gmail, hosted services (Google Docs), video-sharing websites (YouTube), and wikis, such as Wikipedia, are other examples of Web 2.0 or networking technologies.
On Web 2.0’s heels, is Web 3.0, also referred to as the semantic or data-driven web. In this evolution, the data is retrieved from an individual’s unique web searches—the web intuitively adjusts to meet the needs of each user. In other words, if a user does a lot of searching for clothing or shoes, for example, that user will receive more advertisements related to the most frequent search parameters or combinations of items searched for most frequently. Note that a hard and fast definition of Web 3.0 is not possible, since elements and ideas are emerging continuously.
Some benefits of Web 3.0 have become reality largely due to the increasing use of smart phones and cloud applications, paving the way for the ability to access data from almost anywhere. These days, information access is not limited to the home only but wherever someone happens to be. Web 3.0 abilities continue to expand, including allowing televisions to collect user data and enabling smartphones to access data on users’ computers.
Learning Management System
A learning management system (LMS) is the heart and soul of the online education system or classroom that focuses on structured partnerships between students and faculty, which typically include discussion forums and areas for submitting assignments electronically. Some of the other core components of a LMS include the ability to track and manage students, course materials, exams, announcements, email, and grading communication tools. In this LMS environment, faculty have control of what students view, the format in which they see information presented, when content becomes visible to students, and the ability to set timeframes for exams, where applicable. Having control within the LMS permits teaching faculty to be more organized and efficient in how they choose to manage or add to the course content.
Learning is most often asynchronous, requiring the learner to be diligent, self-directed, motivated, and organized, but can also be used where programs are hybrid (a mix of online and face-to-face classes) or in a F2F classroom. Offering courses in online and web-enhanced formats expands the opportunity and flexibility for those students who have either limited, or perhaps no, access to the F2F classroom, where there are specific class meeting times. The LMS (Moodle, Canvas, Schoology, and Blackboard for example) combines a collaborative style learning environment, along with additional learning tools that empower the teaching and learning process. This may include videos, voice-over PowerPoint presentations, or additional educational tools capable of bringing the course to life and adding items of interest to the content, making traditional online learning much more engaging and multidimensional.
Massive Online Open Courses
Massive online open courses (MOOC) are best defined as online courses intended to accommodate, with open and free access, an unlimited number of participants. It is thought that the role of the MOOC is to support lifelong or networked types of learning and to reach large groups of like-minded individuals. Having access to the Internet is the only prerequisite for someone to be able to sign-up and participate. Spring (2016) stated that MOOCs are often used as an opening to attract students to a school or a university, by offering some insight into what the school’s tuition-based courses would have to offer them. At the very least, MOOCs do have the ability to connect large groups of people with large amounts of information. One of the benefits of a MOOC is that it has the capability of providing education to new groups of learners that include the working parent, international students who may have no access or only limited access to higher education, retired individuals, or those seeking lifelong learning. MOOCs have become a part of the regular course offerings of many universities. The concept of building a sense of community, and feeling connected, is thought to be an essential aspect of, as well as motivation for, the student’s journey to success.
Multimedia and Presentation Software
Before the explosion of computers and IT, lectures may have included an easel with posters or hand-drawn diagrams for adding a visual effect for the audience. Others used manually operated projectors (a.k.a., an overhead projector) and transparent sheets overlaid with text or images to illustrate a specific concept or point they wished to emphasize. Today, PowerPoint is one of the most common presentation tools faculty use for lectures or other educational purposes. Also known as productivity software, PowerPoint runs on a computer, and assists the user in the development and enhancement of presentations. This has been a long-utilized teaching companion to a lecture, for displaying content including text, graphs, charts, videos, images, or photographs. Slides offer a visual aid for students, and faculty can make slides available either before or after the lecture as an aid for note-taking and review or for study-guide purposes. Additionally, the faculty is able to keep lectures on track, meet class time constraints, and ensure that no key points are left out of the presentation. PowerPoint is considered to have a straight-forward or linear format, as slides are displayed one after the other, and large quantities of information must be consolidated into brief bullet-point statements. Thus, PowerPoint is not the optimal modality for presentation of more complex material. Contemporary versions of PowerPoint allow presentations to be stored in the Cloud and are accessible from any location with Internet access and via any compatible devices. PowerPoint is compatible with both Mac- and Windows-based computer systems.
If Not PowerPoint, Then What?
Other presentation software includes Keynote, which is compatible with iOS or Apple products, such as iPad, iPhone, or Mac, and like PowerPoint, has a linear or slide type of format. Unfortunately, it is not currently available for Windows-based computers, but is extremely user-friendly, and, if one happens to be a die-hard Mac user, it works well with iCloud, allowing access to the information stored there from anywhere and has many intuitive, built-in animation features.
Prezi is an alternative type of presentation software that uses a map-style background and allows the presenter to tell a story by zooming in on specific components of the map, then back out again, and on to the next point of information on the map. Prezi is also Cloud-based software, allowing for better collaboration among multiple presenters, as well as easy access from any computer. Visually appealing, Prezi can be a welcome change from the traditional linear slideshow flow of a PowerPoint presentation, but it should be noted that the presentation’s movement can cause queasiness for some audience members.
There are some different options in using presentation software for educational purposes. Screencasts, or video screen captures, are an excellent option when there is a need for a quick tutorial or lesson. Usually accompanied by audio, the screencast is essentially a movie, or recording, of what is happening on a faculty member’s computer screen along with voice enhancement, which is then viewed by students on their devices. This is not to be confused with a screenshot, which is a single image of computer screen content. Screencasts can be viewed at a student’s convenience and started, stopped, or repeated as often as desired. Other benefits include the ability to present material visually, such as key points, images, or a step-by-step process. Screencasts are one way to appeal to the visual learner, or to explain a complex concept. Numerous products exist for creating screencasts, and range from free downloads (such as Screencast-O-Matic and Jing) that offer the product with restricted capabilities, to full-version products that must be purchased. Screencasts can provide educators and students the opportunity to extend teaching and learning well beyond traditional limitations and embrace the opportunity to transform the way the information is taught, as well as how students learn.
Social Media
Communication is an important tool in any educational environment, but when used as a teaching tool, social media can be a powerful method of relaying information to a group of individuals. There are many different types of social media, with Facebook being one of the most utilized and well known. Clark (2017) explained that Facebook can be a valuable educational tool because it has the potential to inspire users to collaborate and share knowledge and experiences in a social media group setting, while targeting a specific population. For example, similar to the healthcare professional who has a Facebook group dedicated to reaching Type 1 diabetics, the nurse educator can utilize social media as a tool to get information out to nursing students, or utilize this media to deliver announcements or resources with just a click.
Social media has become an essential part of online daily activity, as social media websites and similar applications multiply. Facebook allows an individual to create a profile; choose privacy options; and upload and share photos, videos, and life events, along with a plethora of other opportunities for staying connected to a specific group or community of individuals. From a business perspective, social media can be utilized to educate, communicate, market, and promote businesses or products, and attract new, as well as stay connected to current, customers. In healthcare, social media can be an inexpensive and far-reaching tool to promote education for patients, for example, by distributing pertinent information related to a specific health condition. This provides the individual with a casual forum where they are able to ask questions, learn, share experiences and tips, or develop and build a support system with others that have similar health difficulties.
Can one Tweet contain a meaningful or powerful message in 280 characters or less? Twitter allows an individual to create a personal Twitter handle; then, using a smartphone, iPad, or computer, the person may send out messages to those who are followers, and retweet or forward messages from those the user is following. Twitter users can also follow specific sites or content, using a hashtag (#) before a keyword (#DiabetesSux or #lovemydog). A study by Waldrop and Wink (2016) found support for the use of Twitter in nursing education, and the authors suggested that, in some respects, it may not yet be utilized to its full potential. Using this technology to send out course-related information, announcements, links to current events, or additional activities for learning has been received well by students. The potential for Twitter use to send out follow-up information to the class to encourage dialog, and after-hours connection and learning from one another, are also positive considerations, which, again, reinforces the sense of community and belonging.
Other commonly used forms of social media include Instagram, a visual sharing application, where photos and videos may be shared by using a smartphone, allowing viewers to like their activity, tag others in specific photos, or leave comments. Interaction on Instagram is the same as other social networking where individual profiles are set up, and photographs posted from those followed are viewed in the follower’s newsfeed and vice versa.
If social networking interests are strictly professional, LinkedIn may be the answer. Individuals interested in growing their professional network or thinking of making a job or career move, often look to LinkedIn because human resource professionals, as well as recruiters, are on LinkedIn. Professionals may collaborate with like-minded individuals who may be able to add value to their line of work, whether locally, nationally, or internationally. LinkedIn allows members to conduct polls on various topics. LinkedIn provides the opportunity for its users to blog, network, post a resume, apply for jobs, and follow specific businesses or specific interests. In other words, it is Facebook for business professionals.
Should social media be used in education? The advantages are numerous, and the opportunity for students to collaborate is a great way for the shy student to open up and post in an online forum, building confidence and encouraging participation. Students may ask a question regarding an assignment or lecture or for assistance by posting to the wall where all group members can see it, permitting all students to review the follow up responses; or they may view an announcement from faculty.
With every positive, there are also negative considerations. In a F2F classroom, the use of social media may prove to be more of a distraction to students, who use it during class time. Additionally, there is always the possibility of untrue or inappropriate information being added to the site, necessitating careful monitoring by the group administrator. There are also issues with privacy being potentially compromised; and, even with the adjustment of privacy settings, there is the possibility of reputation damage if incorrect or outdated information is posted or shared. This can be avoided if the user profile is regularly updated, relevant, and accurate.
Social media users continually connect with one another, sharing information day in and day out, linking students and educators to wonderful resources through the simple click of a mouse, or a touch screen tap. It is far more likely that faculty are the ones that need to be convinced of the value of using technology in the world of education; students have already been won over, so it makes sense to engage students in the online world where they are already very involved!
Web Conferencing
Web conferencing gives attendees an opportunity to attend online or virtual meetings over the Internet. With a computer’s speakers and microphone, a connection to a meeting can be made—even while one is “on the go”—simply by making a telephone call and using a specific phone number and meeting identification code. This can be very advantageous, as individuals from multiple time zones can be connected all at once, without requiring either travel, or the need to find and book a meeting room. Attendees can also easily log into or out of the call with minimal disturbance to other meeting participants, particularly if the meeting room host has the capability of muting all in attendance, to prevent background noises and outside conversations from being audible. Some web-conferencing technology includes video conferencing capability, ideal for presenting difficult concepts, or lecturing to students, giving them a feeling of connection to faculty or peers that—particularly in an online class—makes for a stronger feeling of classroom community, as well as appealing to the visual learner. Just as there are advantages, some of the disadvantages are related to connectivity, audio or video quality, system errors, and virtual conference-room size limitations.
Web conferencing is an excellent tool for the nurse educator, allowing either synchronous or asynchronous access to classroom activities, and adding an interactive element that is appealing to different student learning styles, particularly in distance education. There are times when simply reading assigned materials is insufficient for certain types of content, making it difficult for learners to easily comprehend or keep them engaged. In the F2F classroom, a presenter can lecture to students all over the country with the use of web conferencing, allowing these students the opportunity to virtually attend a presentation that they otherwise would not have been able to. Web conferencing will no doubt continue to evolve and create new opportunities for the way that we can use it to educate our students.
Audience Response Systems
The audience response system (ARS), also referred to as student response systems, or clickers, are utilized in the classroom by using a radio frequency receiver connected to the presenter’s computer, along with individual radio transmitters, which are given to every member of the audience, each with its own identifier. Typically, a PowerPoint presentation is projected, which allows the audience to view the results. Once everyone has had the opportunity to respond or “vote” on a question or poll, the ARS system then collects the audience responses, and presents a graph or aggregated data based upon the results. Some educators may consider this technology antiquated, however. Gousseau, Sommerfeld, and Gooi (2016) suggested that learners may now be engaged via their smartphones, laptops, and/or tablet technology, rather than through traditional clickers.
Issues to consider with the ARS technology include cost, safety and security, training, equipment, updates, and technical support. Additional considerations may include the anticipated types of questions that would be utilized for the ARS system, along with whether or not it would be used simply for question and answers, or individually graded questions. Either way, an ARS can enhance and promote an active and engaged learning environment, and provide quick and meaningful feedback for questions asked of learners.
Academic Electronic Health Record
Nursing education professional organizations have recognized the need for an integration of informatics in nursing programs. The AACN and the QSEN are examples of such organizations that have developed competencies, and strongly recommend that nursing students be well-prepared to access and evaluate patient information using the electronic health record systems (EHRS) used in healthcare facilities (Titzer & Swenty, 2014). School of nursing program and course objectives should be tailored to meet the Essential IV of the AACN Essentials of Baccalaureate Education, which addresses information management and application of patient care technology (American Association of Colleges of Nursing, 2008). The addition of technology-teaching strategies throughout the curriculum also supports the QSEN competencies, which have emphasized the importance of informatics as an area of focus.
Incentive programs have played a large part in the push to bring healthcare into the digital age. The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 requires health care providers and organizations to implement an EHRS, demonstrate meaningful use, and validate improvements made in healthcare safety through the use of health IT (HealthIT.gov, 2016). Clearly, information technology should also be recognized as an important component in the education process, and, along with other innovative strategies, make the education process dynamic and complete.
Videos, Podcasts, and Mobile Applications
Videos have been a part of nursing education since the advent of film. Videos were typically outdated, did not always demonstrate evidence-based practice clearly, and the original intent of the video was often lost due to how distracting, outdated, and egregious the nursing techniques, errors, and behaviors were. Schools of today, however, are more apt to use a laptop and click on YouTube, or an educational website, loaded with demonstration style videos. Almost anything imaginable is available in video format, but the concern is always the authenticity and validity of the information being presented. Particularly with YouTube, faculty must review all content in that it is comprised of content that is uploaded by anyone with video capability. Today anyone with a smartphone can create and upload a video to YouTube. On the other hand, YouTube also offers some privacy settings, which limit the viewing audience and protects copyrighted material from being uploaded to other websites (YouTube help, 2017). However, copyright protection is limited and, eventually, become public domain once works lose their copyright protection. It is paramount to verify whether the material one wishes to use is indeed public domain before uploading it to a personal or educational website, or to YouTube.
YouTube, and sites of its kind, can be a beneficial and engaging learning tool for students of all generations. Options are limitless, and creativity and imagination will only continue to propel the use of this technology even further for the benefit of nursing education.
Podcasts provide another option to enhance the learning experience because the student can access and listen to recordings using an iPod, tablet, computer, smartphone, or MP3 player. A study by Marrocco, Wallace-Kazer, and Neal-Boylan (2014) concluded that “faculty and students appreciated the many positive aspects of podcasting; including the ability to create a venue for hesitant students to participate in class discussion and provide asynchronous education that spanned learning and geographic barriers” (p. 52). The video podcast is also a consideration, when an audio file is insufficient for presenting a topic that would be better explained using video in addition to the audio. These files are shared via the Internet in the form of a recorded lecture (with or without video), or an informational discussion, and students are then able to access them using their smartphones, computers, or tablets. Video podcasting is very similar to what is found on YouTube, which includes both audio and video. Podcasts alone are also an excellent way for faculty to notify students of emergency situations necessitating class cancellation, or learning-management system outages. Either way, this technology is one way to engage learners who prefer to listen to a lecture, whether F2F or online. Many of the application downloads are free and easy to use, even for the beginning podcaster. Audacity, Auphonic, and Camtasia are some examples of podcast and video podcast products that are available. It is always advisable to research compatibilities, security, and support prior to use of any downloaded app.
Simulation and Virtual Learning Environments
The topics of simulation and virtual learning environments are covered more extensively later, but it is worth mentioning that simulations today are the descendants of the first simulation manikin, Mrs. Chase, used in schools of nursing in the early 1900s. Figure 17-1 depicts Mrs. Chase, as well as a few of the simulation manikins available today. Considered by today’s standards to be a low-fidelity manikin, Mrs. Chase was utilized to teach basic nursing tasks, such as making an occupied bed, bathing, dressing, bandaging, and patient-transfer techniques. Fast forward 100 plus years to Sim Man 3G, which is capable of breathing, showing signs of arrhythmias, bleeding, and seizures, as well as exhibiting a host of neurological, cardiovascular, trauma, and wound-care symptoms. Nearly any emergency situation can be replicated in a realistic manner through the magic of simulation. The method of experiential learning is a method that allows the student to practice skills, through a hands-on style of learning, without causing harm to any patient in the process.
3-D Virtual Learning Environment
The term, virtual learning environment (VLE), has been defined broadly as “a system for delivering learning materials to students via the web” (Oxford University Press, 2016, para. 1). However, for the purpose of this chapter, virtual learning environments will refer to learning that occurs in three-dimensional (3-D) VLEs such as Second Life (SL). Ahem and Wink (2010) described SL as an “Internet-based, multiplayer virtual world designed by its residents, called avatars” (p. 225).
A virtual learning environment consists of multiple strategies that can include a computer- or Internet-based platform. It may be found with an online classroom, or interactive, asynchronous learning environments, such as Second Life or Shadow Health, which are an enhancement to the computer- and Internet-based platforms. Students using avatars are immersed in role-playing, or situational learning activities, that bring to life a circumstance that requires a response from the student. Students can role-play “in world” with Second Life, where a personal avatar is created and is capable of interacting with specific areas of the environment or other avatars. Shadow Health, creator of Digital Clinical Experiences, includes a natural language conversation engine with both speech-to-text and typing options through which the Digital Standardized Patient responds verbally to key questions that are asked by the student. At this point in time, these avatars have the capability of responding to more than 300,000 questions. Technologies such as this afford students the opportunity to interview and conduct a physical assessment of a virtual patient, while learning to formulate and organize assessment questions, respond empathetically, and provide patient education (Foronda, et.al, 2017). Figure 17-2 depicts a Shadow Health standardized patient.
3-D virtual learning environments are a form of multiuser virtual environments (MUVEs), and are especially useful when a teacher needs to design safe learning experiences that meet specific objectives (Calandra & Puvirajah, 2014). As with other forms of simulations, students can make mistakes, receive formative feedback, and improve their decision making without risking a patient’s health or life.
Getting Started in 3-D VLE
Joining SL and designing an avatar are free, but real estate and fixtures are not. In addition to the cost of real estate, the cost of designers, programmers, and technical help staff must be considered when using 3-D VLEs. Information and advice about how educators can access resources are available on the “Second Life Wiki Education/Resources” page (2017a).
To provide a safe environment for learning, educational institutions buy SL islands and make those islands private to protect students and staff members from pesky and inappropriate “griefers” (SL users who harass other users). While selected SL public sites are available, the uninterrupted learning and the psychological safety of students should be considered. Educational and nonprofit organizations can purchase islands at a discount from Linden Labs (Second Life Wiki, 2017b) and make them private or public. For example, public islands, such as the HealthInfo Island, provide information on a variety of health issues; the American Cancer Society has a public island on SL; and a few public islands owned by colleges of nursing are also available. Getting started in SL requires patience while becoming accustomed to its features; consultation and programming by experts, and funds for purchasing private assets comprise other considerations.
Theories Applicable to 3-D VLE
Underlying Theories
Social Presence and Immersion.
The theories related to the 3-D VLE concern the experience participants have within the environment. Acting through avatars, participants and facilitators alike experience a sense of social presence due to immersion into the 3-D VLE (Esteve-González, Cervera, & Martínez, 2016). This immersion sets the stage for educational activities, such as group meetings or simulations, where interactions among participants and facilitators feel real. Figure 17-3 depicts a nursing student providing patient care in Second Life. Reality, or fidelity, is important in simulation design (Jeffries, Rodgers, & Adamson, 2016), but in 3-D VLEs, the reality is related to the perception of being an actual person interacting with others within the virtual environment. Beck, Fishwick, Kamhawi, Coffey, and Henderson (2011) describe a phenomenon called sentient presence, which means that avatars are present in the physical environment while thoughtfully interacting in a virtual society. The physical environment is enhanced by the ability of avatars to communicate and express their public personalities. This collaborative interaction results in learning, according to social constructivists (Beck et al., 2011).
Social Constructivism.
Since learning occurs in the interactions and tasks available in the 3-D VLE, social constructivism explains the learning that results as students work together. According to Vygotsky’s social constructivist theory (1980), learning is developed by individuals as they interact with each other in a socially-constructed environment, such as Second Life. For example, Salmon, Nie, and Edirisingha (2010) investigated the learning activities of students in archeology, media and communications, and digital photography. They described a five-stage model that illustrates the process of social constructivism in their study. When this process was applied, students entered the environment and learned how to log on, name their avatars, and practice communicating and moving around. They then began interacting with each other, exploring, communicating, and working together in various activities, getting to know each other as they learned. As they began to know other students, they shared information, sought ways to network, and helped each other meet their goals. Finally, they began to understand not only what they learned, but also how they learned through their efforts to learn together. Nursing students in SL, in addition to participating in clinical simulation, can also practice various graduate-level roles in 3-D VLEs, such as in an educator, executive, or informatics role.
Designing Simulations—The NLN/Jeffries Theory
The NLN/Jeffries theory was designed to guide simulation experiences (Forneris & Fey, 2016). It features several concepts: the context, or place and purpose of a simulation; the background, such as goals for student learning and place in the curriculum; the design of the simulation, including its content and problem-solving elements; the experience itself; the facilitator; the educational strategies included; the participants; and the expected outcomes. Thus, within a given context, and assuming given goals for a simulation, educators ask themselves, “What content and problem-solving activities can we design, and what types of facilitation and educational strategies could we use to help students achieve the expected learning outcomes of the simulation?”
Though the literature focuses on applying this theory in bricks-and-mortar simulation labs, the same concepts and relationships can be applied in 3-D VLEs. For example, in a mental-health nursing course, students can perform a needs assessment in the home for an avatar-patient, and practice therapeutic communication. The context is the home setting, and the student goals would be to conduct a needs assessment and to speak to the patient-avatar therapeutically. In designing the simulation, one student could play the part of the patient, with a scripted set of challenges to present to another student playing the part of the nurse. The educator would give feedback to the students and lead a debriefing session to evaluate the outcomes of the simulation. The NLN/Jeffries theory provides an evidence-based tool for designing 3-D VLE simulations that is useful for planning.
Instructional Methods Used in 3-D VLEs
The literature on learning activities that can be used in 3-D VLEs is extensive. They have been categorized into four broad categories: communicating/collaborating, building/creating, exploring/processing, and role play/simulation.
Communicating/Collaborating
A major advantage of SL is the ability to meet together, communicate, and collaborate (Ludlow & Hartley, 2016). Communication can take place through SL speakers or on telephone conference lines. Additionally, teachers and students can get together and participate in written chats, producing transcripts that can be saved, analyzed, and discussed. Avatars can instant message (IM) each other, locate each other, and teleport throughout a SL island. Organizational meetings can be conducted in SL, with avatars representing each member sitting in a virtual room together, and includes notecards for agendas, and web pages accessible through SL browsers.
Students can also participate in networking sessions or even celebrate their accomplishments. Some documented examples of communicating/collaborating include (1) a perioperative continuing education conference sponsored by the University of Texas at Arlington College of Nursing site in SL, which was designed by nursing informatics students (Baker & Brusco, 2011); (2) a journal club conducted across seven different health organizations and conducted in SL (Billingsley, Rice, Bennett, & Thibeau, 2013); and (3) nursing students practicing communication with each other to collect health histories that included potentially embarrassing content (Sweigart & Hodson-Carlton, 2013).
Building/Creating
The 3-D VLE environment would be quite sterile without buildings, furniture, and various fixtures. These can be designed in place for students, or students can learn to program and set up environments that match the teaching that is anticipated. An example of this type of activity was described by Cook (2012), in a virtual pediatric primary-care clinic designed by family nurse-practitioner students. They applied a model by de Freitas and Oliver (2006) that considered the situation or context to be displayed, the pedagogy or learning activities that would be used, the characteristics of the learner, and the design needed to build such a clinic. Note that building a clinic in SL often requires staff help to build and furnish structures with required equipment. Otherwise, there is a steep learning curve for the instructor in SL.
Students can also build business plans, models, posters, and other artifacts in SL for future learners. For example, students in a teacher-education study in Second Life designed a professional development plan (Hartley, Ludlow, & Duff, 2015), and nursing students in a care-coordination simulation in SL successfully designed a patient-teaching plan for their virtual patients (Holland, Tiffany, Tilton, & Kleve, 2017). Many examples of posters designed for learning can be found through exploration of various university or nonprofit organizations, such as the University of Texas at Arlington Second Life poster exhibit, where nursing students’ research posters are displayed. The exhibit can be accessed by going to this Second Life URL and signing in: http://maps.secondlife.com/secondlife/UTArlington%20III/196/197/23). Any learning objects students can create in this world, such as images, artwork, or photographs, can be left as artifacts for future learners to view or experience.
Exploring/Experiencing
SL field trips are commonly described in the literature. For example, as part of the orientation for a research course designed for graduate students in psychology, students were assigned to explore the UCLA library and other sites (Fitzsimons & Farren, 2016). Students took pictures in-world during their tours as they worked individually and in groups. Finally, they proposed research hypotheses and survey questions, thus gaining authentic experiences as researchers. Some of the advantages described by Fizsimons and Farren were the ability to help students work in groups as well as on individual assignments, and improve students’ negotiation skills as they worked in groups.
Likewise, Koivisto, Multisilta, Niemi, Katajisto, and Eriksson (2016) studied the efficacy of using an experiential game in a 3-D VLE in which students applied the nursing process in caring for virtual patients. Students reported that they learned most when interviewing virtual patients and implementing interventions, providing some confirmation that clinical reasoning can be developed within 3-D VLEs. Another example of student exploration in SL was designed for community-health nursing students at the University of Wisconsin-Oshkosh (Schmidt & Stewart, 2010). Although an older study, the idea can still be applied today. The faculty used a public health department in SL to display a description of public health, its purpose, and its services. This display demonstrated various public-health activities, such as the Women, Infants, and Children (WIC) program and sanitation, as well as links to support groups in SL. Yet another example is an experience described by Reinsmith-Jones, Kibbe, Crayton, and Campbell (2015), who assigned an exploration of a model of the United States Holocaust Museum in Washington, DC, to educate social work students about the experiences of German Jews in World War II. Thinking creatively, real-world attractions can be replicated “in world” in various academic fields.
Role Play and Simulation.
Clinical simulations in SL are challenging because actual hands-on skills are not possible. However, students can set priorities, interview patients, and care for patient avatars based on history and physical data. Students can also try out new roles and solve problems “in world” (Esteve-González, Cervera, & Martínez, 2016) through various learning activities. This type of simulation should be carefully structured around expected learning outcomes to assure authenticity. For example, Kidd, Knisley, and Morgan (2012) used a 3-D VLE to teach undergraduate students to complete mental-status tests in a mental health course. Students successfully completed mental health assessments and health histories on virtual patients played by their instructors.
Students can also practice communication and assessment skills in a safe environment in SL. For example, Schaffer, Tiffany, Kantack, and Anderson (2016) used three scenarios in SL to provide clinical experiences in an undergraduate community-health nursing course: an airplane crash, a family health situation, and a home safety assessment. Finally, Rose (2013) described a 3-D VLE simulation in which students received a report on a patient who needed pain medication and a dressing change. After the script was played, two students worked together to develop a care plan for the patient and reflected on the simulation and what they learned.
Developing Learning Activities in 3-D VLEs
Many examples of communicating/collaborating, building resources, exploring/experiencing, and role-play and simulation are described in the literature outlined previously. Other learning activities can be designed within each category, based on expected learning outcomes, by brainstorming or adapting real world assignments into “in world” activities. Some specific ideas for implementing each category of learning activity are displayed in Figure 17-4.
Assessment of Learning in 3-D VLEs
Challenges
Though younger, traditional students have been exposed to technology-based learning methods, not all students embrace applications such as SL. Their resistance is not entirely baseless—new skills need to be learned, the technology is sometimes unreliable, and some of the student computer systems may be inadequate for the task at hand. Additionally, students need to be oriented to the skills needed in SL, which takes valuable class time. Therefore, faculty members need to plan ahead and make clear expectations for their students (Hartley, Ludlow, & Duff, 2015).
Student Satisfaction versus Learning Outcomes
Most research conducted on teaching in SL or other 3-D VLEs has focused on student satisfaction. By far, the greatest negative feedback from students is on difficulties with the technology, including getting in and operating it, and having trouble walking or talking. However, other types of satisfaction have been measured. For example, Foronda, Lippincott, and Gattamorta (2014) found that, although students reported anxiety at the beginning of learning in SL as well as technical difficulties, they also expressed appreciation with the support provided by the instructors, and appreciation for the experience and skill-development.
Though student satisfaction is important, a satisfied student is not necessarily an educationally successful student. Whether students have actually met learning outcomes also needs to be assessed. Learning-outcome measurement in 3-D VLEs is similar to assessment in other contexts. When a 3-D VLE is used within a course, examinations, projects, and student papers can be used to assess whether students meet course or unit objectives, and to compare 3-D VLE versus onsite sections of a course. Likewise, rubrics can be used to evaluate how well students meet learning outcomes when they complete a simulation, whether live or videotaped. Other outcomes that have been used in 3-D VLE research include learning self-efficacy (Cheong, 2010; Xu, Park, & Back, 2011), student engagement (Pellas & Ioannis, 2015; Schaffer, Tiffany, Kantack, & Anderson, 2016), reflective journaling (Tandy, Vernon, & Lynch, 2016), and debriefing.
Debriefing
Several debriefing tools have been used for high-fidelity clinical simulation, but little has been published on debriefing specifically in SL. Some of the most common tools for debriefing in high-fidelity simulations include Debriefing Assessment for Simulation in HealthCare (DASH) ©, a tool developed by the Center for Medical Simulation (Brett-Fleegler, Rudolph, Eppich, Monuteaux, Fleegler, Cheng, & Simon, 2012), debriefing with good judgement (Rudolph, Simon, Raemer, & Eppich, 2008), debriefing for meaningful learning (DML) (Dreifuerst, 2015), and plus-delta (Decker, Lopreiato, & Patterson, 2013). Most of these models involve students reflecting upon what went well in a simulation, what did not go well, and what could be improved, while being respectful of students and other participants, and promoting critical-thinking skills through effective questioning. Since existing debriefing tools focus on high-fidelity clinical simulation, research is needed on developing debriefing tools uniquely suited to 3-D VLEs.
High-Fidelity Simulation
As the fidelity of a simulation increases, the quality of the experience increases along with the resources required to offer it. Decisions regarding the level of fidelity to offer should consider whether the return on investment of time, money, and effort are necessary. In general, the lowest level of fidelity should be chosen that will satisfy the objectives for the simulation.
When is high-fidelity simulation warranted? The National Council of State Boards of Nursing published the results of a study on the use of simulation to replace clinical experiences in 2014, and found that up to half of the clinical hours in a prelicensure program could be substituted with high-quality simulation (Hayden, Smiley, Alexander, Kardong-Edgren, & Jeffries, 2014).
Students with all types of learning styles value high-fidelity simulated experience (Tutticci, Coyer, Lewis, & Ryan, 2016). A well-designed and managed simulation can prepare them adequately for professional practice.
The complex technologies needed to conduct high-fidelity simulation are major barriers to its implementation (Al-Ghareeb & Cooper, 2016). Faculty training to increase the skill level of those managing simulated experiences, along with technical support, can reduce this problem (Doolen et al., 2016).
The design of high-fidelity simulation varies widely. Further research is needed to determine best practices for creating these experiences to achieve an optimal level of learning.
Lack of time is another frequently cited reason for the avoidance of high-fidelity simulation (Al-Ghareeb & Cooper, 2016). Strategies to address this include hiring dedicated simulation staff, which requires administrative support.
Even when there are knowledgeable and skilled staff and sound educational designs, lack of funding may limit the level of fidelity that can be realistically offered (Doolen et al., 2016). One approach to managing cost is to create regional simulation centers that serve several organizations, including colleges and healthcare institutions. Education and practice partners may collaborate on funding and operating a regional center, or outside users may pay a fee to utilize the services of the center.
Student Evaluation
Students engaged in high-fidelity simulation may be evaluated in a number of ways. One is through the use of video capture of the simulation. Video lets educators review student performance multiple times and make more accurate assessments, especially during high-stakes scenarios. Students may review their actions on video to promote self-critique. The benefits of video-assisted debriefing over standard oral debriefing when comparing performance and stress have yet to be proven (Rossignol, 2017). The extra cost and complexity of videotaping simulation should be weighed when pursuing this option.
Debriefing after Simulation
Debriefing following a simulation is a key activity that helps educators elaborate on lessons to be learned, and lets students express their understanding of the experience. Although debriefing can encompass elements of student assessment, it is not the same (Dreifuerst & Decker, 2012). Debriefing is appropriate following all types of simulation, including those that incorporate high-fidelity simulations, that may include formal evaluation along with assessment, critique, and grading. In this instance, debriefing is an opportunity to review the findings of the evaluation.
has published standards of best practice regarding debriefing that describe criteria and required elements (INACSL Standards Committee, 2016). Debriefing must be conducted in a supportive learning environment by a competent person who was attentive during the simulation. The information shared during the debriefing should be based on a theoretical framework and align with the simulation’s objectives and outcomes.
Technical Support for Simulation
When microcomputers first emerged in the early 1980s as teaching tools for nursing students, many educators purchased hardware and software for their new computer centers with the belief that this would revolutionize nursing education. But they were disappointed when computer-based learning was not immediately embraced. Kathleen Mikan (1980), an early pioneer in IT for nursing education, was one of the first nurse educators to notice that much of the material purchased was underutilized, explaining that the mere availability of a computer does not ensure its use. And the same holds true for each new generation of IT that has followed, including simulation, where the mere availability of simulators, trainers, manikins, and virtual environments does not ensure that educators and students will intuitively understand how to learn from them.
The role of the educator in simulation varies. Some are solely responsible for every aspect of the simulated experience, including creating the physical space, designing the instructional approach, and teaching the learners. This may be a necessity in a small school or institution where there are few staff. Most educators are supported by others who assume roles such as programming and maintenance. This allows the educator more time to focus on the pedagogical aspects of simulation, from assessing ways to integrate simulation into the curriculum, to evaluation of its effectiveness in achieving educational outcomes. Job titles for support personnel include simulation technologist, simulation coordinator, and simulation specialist. Informatics nurse specialists (INSs) often fill these roles.
Vendors who sell products may provide education and training for clients as part of the purchase agreement, or as a separate contract. Another arrangement is to sign a service agreement where the vendor will provide the clients with ongoing support via phone, email, or on-site visits to install, repair, troubleshoot, or maintain simulation products.
A review of current practices regarding simulation may reveal gaps where support is needed. Whether to have internal staff provide support, or to contract for this service, requires careful consideration of the knowledge and skills of personnel, and how best to utilize their time and efforts to learn and carry out support functions.
Certification in Simulation
Certification in healthcare simulation is still relatively new. The Society for Simulation in Healthcare (SSH) offered the first certification for healthcare simulation experts in 2011 (Rutherford-Hemming & Lioce, 2015). There is an increasing demand for verification of competency prior to employment in positions where significant resources are allocated to the design and development of simulated-learning experiences. On-the-job training is giving way to formal programs and educational degrees where simulation specialists learn industry standards for best practice, and receive external validation of their knowledge, skills, and attributes (Decker, Lopreiato, & Patterson, 2015).
Reasons to become certified include gaining professional recognition and demonstrating knowledge and skill to employers, peers, and the public. Advantages include increased networking among colleagues that will nurture the sharing of insight and experience. SSH offers three certifications: the Certified Healthcare Simulation Educator (CHSE), the Certified Healthcare Simulation Educator-Advanced (CHSE-A), and the Certified Healthcare Operations Specialist (CHSOS). The CHSE must have a minimum of a bachelor’s degree and two years of continuous use of simulation in the education role (Society for Simulation in Healthcare, 2017a). The CHSE-A certification is for advanced leaders in healthcare simulation who have a master’s degree and five years of experience in simulation in the education role (Society for Simulation in Healthcare, 2017b). The third certification, CHSOS, has similar requirements to the CHSE, but is also focused on the simulation operations role. All candidates must successfully pass an examination to earn any SSH certification (Society for Simulation in Healthcare, 2017c).
The workforce encompasses a growing number of simulation technicians. Training may result in awarding a certificate of attendance, but more associate degree programs are educating graduates in healthcare simulation technology to prepare them for the field (Escobar-Castillejos, Noguez, Neri, Magana, & Benes, 2016).
Future Directions
Where will informatics in education go from here? It is quite clear that the information age mindset of students today has led educators to seriously evaluate and change the ways that the teaching and learning process is delivered, and the ways in which students will learn. As information technologies evolve, they will continue to have a lasting impact on the way that the curriculum is delivered, how nursing students are taught, and how the nurses of tomorrow will begin their professional practices in a rapidly paced and continually evolving world of healthcare. Traditional methods of nursing education must also move into the twenty-first century to meet these challenges and to adequately prepare the next generation of nurses for the increasingly complex challenges they will face. The world of nursing education must keep up with technological trends and advances to enhance the curriculum and educational process as healthcare continues to rapidly change and evolve.
